Which Prescription and OTC Drugs Are Just Fine to Use in Recovery?

Can the prescription and OTC drugs you take REALLY play a role in successful recovery from addiction? Early in recovery, we are taught that if we want to stay sober, we may have to make wholesale lifestyle changes – avoiding the people, places, and things that may trigger a relapse into active drinking and using. Among the things we are taught to avoid are certain prescription medications and over-the-counter remedies, such as:

• Opioid painkillers (Vicodin, OxyContin, Tramadol, etc.)
• Benzodiazepine tranquilizers (Xanax, Klonopin, Valium, Ativan, etc.)
• Sleeping pills, even those that are not benzodiazepines (Ambien, Lunesta, Sonata, etc.)
• ADHD medications (Adderall, Ritalin, Concerta, etc.)

But all of this is easier said than done. After all, what are you supposed to do when you have a legitimate condition – pain, difficulty sleeping, or anxiety, for example? Let’s take a look at some safer alternatives – prescription medications and OTC medicines that won’t jeopardize your sobriety or your successful recovery.

Pain Relief Alternatives to Opioids

“In fact, my need for the opioid painkillers had reawakened an addiction to narcotics that had been in hibernation for over 15 years… My chronic pain gave me medical permission to dive into my real dope of choice, as the serpent of my addiction awoke full force and began to devour me.” ~ Dan Manger, MSW, Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain Unfortunately, there are many legitimate reasons why you can suffer acute or chronic pain – injury, surgery, arthritis, or a degenerative condition, for example. And just because you are in recovery from addiction doesn’t mean that you have to be in continual pain. Here are some safer possible pharmaceutical remedies, as well as other practical tips you can use to alleviate pain without increasing your risk of relapse.

Acetaminophen for Pain Relief

Acetaminophen – commonly sold as Tylenol – is the most-used pain medication in the United States. In fact, it is so effective, it is on the World Health Organization’s List of Essential Medicines. Acetaminophen is recommended for mild to moderate pain, including:

• Arthritis – recommended by the American College of Rheumatology for arthritis of the knee, hand, or hip.
• Lower Back Pain – recommended as a first-line treatment by both the American College of Physicians and the American Pain Society.
• Headaches – when combined with caffeine, acetaminophen is recommended as a first-line treatment for migraines or tension headaches by the German Neurological Society.

Acetaminophen combined with NSAIDs is also particularly effective when treating postoperative or dental pain.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) for Pain Relief

NSAIDS help alleviate pain by reducing inflammation and decreasing the level of pain-causing hormones in your body. Prescription and OTC NSAIDs include:

• Aspirin
• Celecoxib (Celebrex)
• Diclofenac (Cataflam, Voltaren, Arthrotec (combined with misoprostol))
• Diflunisal (Dolobid)
• Etodolac (Lodine, Lodine XL)
• Famotidine/Ibuprofen (Duexis)
• Fenoprofen (Nalfon, Nalfon 200)
• Flurbirofen (Ansaid)
• Ibuprofen (Motrin, Tab-Profen)
• Indomethacin (Indocin, Indocin SR, Indo-Lemmon, Indomethagan)
• Ketroprofen (Acton, Orovail, Orudis)
• Ketorolac (Sprix, Toradol)
• Meclofenamate (Meclomen)
• Mefenamic Acid (Ponstel)
• Meloxicam (Mobic)
• Nabumetone (Relafen)
• Naproxen (Aleve, Naprosyn, Anaprox, Anaprox DS, EC-Naprosyn, Naprelan, Naprapac (copackaged with Iansoprazole))
• Oxaprozin (Daypro)
• Piroxicam (Feldene)
• Sulindac (Clinoril)
• Tolmetin (Tolectin, Tolectin DS, Tolectin 600)

Antidepressants for Pain Relief

Tricyclic antidepressants provide relief by increasing production of the neurotransmitters in the spinal cord that inhibit pain signals. Although they do not immediately relieve pain, antidepressants begin providing moderate relief for chronic pain after about a week. Some of the conditions most helped by antidepressants include:

• Tension headache
• Stroke
• Spinal cord injury
• Shingles
• Radiculopathy
• Peripheral neuropathy
• Pelvic pain
• Migraine
• Lower back pain
• Fibromyalgia
• Facial nerve pain
• Diabetic neuropathy
• Arthritis

Some of the more common tricyclic antidepressants used to treat pain are:

• Nortriptyline (Pamelor)
• Imipramine (Tofranil)
• Doxein
• Desipramine (Norpramin)
• Clomiptamin (Tofranil)
• Amitriptyline

Anticonvulsants for Pain Relief

Anticonvulsants such as pregabalin, gabapentin, and carbamazepine can be used to treat the neuropathic pain from many health conditions, including:

• Thyroid Disease
• Syphilis
• Spinal Surgery
• Spinal Cord Compression
• Shingles
• Multiple Sclerosis
• Multiple Myeloma
• HIV Infection
• Herniated Disc
• Facial Nerve Problems
• Diabetic neuropathy
• Chemotherapy
• Arthritis of the Spine
• Amputation
• Alcoholic Neuropathy

Relieving Pain without Medication

According to the latest opioid prescribing guidelines from the Centers for Disease Control and Prevention, non-pharmacological therapies are now the first-line treatment for most kinds of pain. This is good news for people in recovery, because it means there are several lifestyle changes they can make and good habits they can start that will go a long way towards effectively managing their pain without risk of relapse.

• Acupuncture – A 2012 study published in the Archives of Internal Medicine shows that acupuncture clearly has a “robust” effect on neck, back, and shoulder pain, as well as headaches and arthritis.
• Cognitive Behavioral Therapy – CBT is recognized by the Veterans Administration as an evidence-based method to alleviate and manage pain.
• Diet –Studies have shown that low-carb diets can reduce pain and inflammation.
• Exercise –Exercise has been shown to help with nerve pain, as well as joint pain and stiffness, by reducing inflammation.
• Hypnosis – Up to 75% of people treated with hypnosis realize “substantial” pain relief.
• Meditation – Mindfulness meditation reduces pain while bypassing opioid receptors in the brain.
• Music – People exposed to music have a 70% greater chance of obtaining pain relief as unexposed people.
• Supplements – According to the Arthritis Foundation, there are a several dietary supplements that reduce pain by promoting cartilage growth, reducing inflammation, and boosting serotonin levels. Some supplements have been shown to reduce joint pain by as much as 50%.
• Weight loss – Even a moderate 10% weight loss can significantly reduce back, hip, knee, and ankle pain. Combining weight loss with exercise can mean a 51% reduction in pain.
• Yoga – Practicing yoga bulks up the brain’s gray matter,  boosting resistance to pain.

Tranquilizing Alternatives to Anti-Anxiety Benzodiazepines

Benzodiazepines are so addictive that a dependency develops in as little as two weeks, even when taken as directed. Benzodiazepine addiction can make abrupt withdrawal potentially life-threatening. Benzo drugs are only supposed to be prescribed as short-term remedies, but there are other, safer alternatives that can help alleviate anxiety.

• Buspirone (BuSpar) – Available only by prescription, buspirone can be used short- or long-term to treat Generalized Anxiety Disorder. Buspirone is NOT associated with:
  • Euphoria
  • Sedation
  • Cognitive Impairment
  • Physical Dependence
  • Abuse
  • Addiction
  • Withdrawal

Buspirone does work immediately – it takes between 2 and 4 weeks for it to become effective.

• Atypical Antipsychotics – Considered to be safe and effective alternatives to addictive benzodiazepines. One caveat – they take 2 to 3 weeks to become effective.
• Atypical antipsychotics include:
  • Aripiprazole (Abilify)—May increase the risk of compulsive eating, gambling, or sexual behavior.
  • Asenapine (Saphris, Sycrest)
  • Blonanserin (Lonasen)
  • Clozapine (Clozaril)
  • Iloperidone (Fanapt, Fanapta)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

• Anticonvulsants—Reduce the activity of certain neurotransmitters, thereby easing anxiety. Both pregabalin (Lyrica) and lamotrigine (Lamictal) have shown promise.
• Antidepressants—Most medications given for depression also benefit anxiety. Especially helpful are Selective Serotonin Reuptake Inhibitors (SSRIs).
  • Citalopram (Celexa, Cipramil)
  • Escitalopram (Cipralex, Lexapro)
  • Fluoxetine (Prozac, Sarafem)
  • Fluvoxamine (Dumyrox, Faverin, Fevarin, Floxyfral, and Luvox)
  • Paroxetine (Paxil, Seroxat)
  • Sertraline (Zoloft)
• Antihistamines—Only recommended for the short-time treatment of anxiety, antihistamines produce a sedating, calming effect. Cetirizine (Zyrtec) and Hydroxyzine (Atarax and Vistaril) are examples of antihistamines with anxiolytic properties.
• Kava—Originating among Pacific Ocean cultures, dietary supplements containing Kava have been reviewed, and evidence suggests it can be considered as a short-term remedy for anxiety.

Relieving Anxiety without Medication

During the recovery process, we learn how to recognize and deal with stress. Many of these techniques also reduce anxiety.

• Exercise – Research conducted by the University of Georgia determined that people who exercise regularly experience a 20% decrease in anxiety symptoms.
• Deep-Breathing Exercises –Practicing abdominal breathing for 30 minutes a day will reduce anxiety.
• Hot Shower or Bath –The warming sensation of a hot shower, bath, or spa releases serotonin, a neurotransmitter known as the “happy molecule” because of its mode-enhavcing properties.
• Take a Nature Walk –50 minutes of exposure to natural greenspace results in improved anxiety and working memory.
• Meditate – Meditating 30 minutes a day results in a 38% decrease in depression and anxiety.
• Drink Tea – Drinking chamomile or green tea  reduces anxiety symptoms.
• Eat More Fish – Eating 36 ounces of fatty fish 3 times a week can result in a 20% decrease in anxiety symptoms. Fish oil tablets may not deliver the same benefit.
• Soothing Sounds – Listening to calming nature sounds or music with about 60 beats per minutes changes brain function “to the same extent as medication.”
• Self-Talk – Pumping yourself up with statements like “I am EXCITED!” before an activity that normally triggers anxiety helps with performance anxiety.
• Get Plenty of Sleep – Experts recommend 7-9 hours per night. Insomnia is associated with greater levels of anxiety and depression.
• Practice Yoga – The regular practice of yoga increases thalamic GABA levels, similarly to anti-anxiety medications – by up to 27%.  Encouragingly, the longer yoga is practiced, the more these benefits are realized.
• Take Multivitamins –Regularly taking multivitamins can reduce anxiety by up to 68%.
• Get a massage – Receiving a 1-hour therapeutic massage once a week for 3 months can reduce symptoms of anxiety by up to 50%.

The Problem with Sleeping Pills

Insomnia is one of the most frequently-heard complaints from people in recovery from drug addiction or alcoholism. Research has suggested that the ability/inability to experience regular, quality sleep is an extremely-accurate predictor of relapse.  Nearly half of recovering alcoholics who suffer untreated sleep problems relapse within five months. But prescription sleeping pills are unsafe for recovering addicts and alcoholics, since most prescription sleep medications are also seriously addicting. Dependence on benzodiazepine tranquilizers can develop within 2 weeks. Even non-benzo sleeping pills, such as Lunesta, Sonata, or Ambien, can double the risk of major depression. This is significant, because 50% of alcoholics already struggle with clinical depression. Sleeping pills are also associated with a much greater risk of early death— even when taking less than 20 pills a year. As bad as sleep deprivation is, the situation, almost invariably resolves itself naturally. But over the short-term, there are safer pharmacological and behavioral remedies that can help.

Antipsychotics as a Sleep Aid?

Some antipsychotic medications have sedating properties, without being addictive. Because of this, many physicians prescribe low doses of atypical antipsychotics as off-label sleeping aids for patients who are prone to substance abuse. However, current research does not support any long-term significant benefit to prescribing antipsychotics such as Seroquel for sleep. The FDA has NOT approved the prescription of antipsychotics or insomnia.

What About Antihistamines for Sleep?

Although many people use OTC antihistamines such as diphenhydramine/Benadryl as sleep aids, experts warn against their regular use. Among the problems—poor quality sleep, sleepwalking, and an altered mental state. Dr. Philip Alapat, Assistant Professor of Medicine at Baylor University, says, “Using Benadryl or any antihistamine for sleep has no long-term benefit. Most people develop a tolerance very quickly.”

The Problem with ADHD Prescription Stimulants

The typical medications used for ADHD – Adderall, Ritalin, Vyvanse, Concerta – are strong stimulants with a high potential for abuse, especially among older teenagers and young adults as euphoriants or supposed performance-enhancing study aids.

Non-Stimulant ADHD Medications and Supplements

Non-stimulant medications do not pose the same risk of divergence, abuse, or addiction as the better-known stimulant ADHD drugs. They also do not cause agitation or interfere with appetite or normal sleep.

• Atomoxetine (Strattera) – Boosts the levels of norepinephrine, increases attention span, lessens hyperactivity, and decreases impulsive behavior
• Clonidine ER (Kapvay) – Actually tested to be more effective in reducing symptoms than stimulants.
• Guanfacine ER (Intuniv) – Improves the regulation of behavior and attention by the prefrontal cortex.
• Roman Chamomile
• Valerian
• Passionflower
• Lemon Balm
• American Ginseng
• Ginkgo

Improving ADHD through Diet

Because ADHD has been linked to nutritional deficiencies, many physicians believe that by altering the diet and correcting those deficiencies, ADHD cases can improve without stimulant medications. Foods containing the following should be avoided:

• Highly-processed foods
• Preservatives
• Artificial flavors
• Artificial colors
• Artificial sweeteners
• Sugars
• Naturally-occurring salicylates

On the other hand, supplements, and foods rich in the following should feature prominently in an anti-ADHD diet:

• Protein
• Complex carbohydrates
• Magnesium
• Vitamin B6
• Zinc
• Essential fatty acids
• Amino acids

Treating ADHD without Medication

As is the case with any behavioral disorder, there are many different strategies that can lessen symptoms of ADHD, whether used alone or in conjunction with non-stimulant medications.

• Behavioral therapy
• Cognitive behavioral therapy
• Exercise
• Massage
• Sufficient sleep
• Yoga
• Meditation
• Limiting “screen time” on electronics’
• Increasing time spent in nature
• Neurofeedback

The Bottom Line on Prescription Drugs, OTC Remedies, and Safer Strategies                                                                              

As you can see, there are many options for someone who needs to treat a legitimate condition without resorting to highly-addictive prescription medications that can sabotage successful sobriety. Because many prescription drugs, OTC remedies, and supplements have unpleasant or dangerous interactions and contraindications, ALWAYS talk to your doctor before you begin or stop taking anything. Remember, your doctor can’t properly or safely prescribe anything if they don’t have a complete picture of what you take. Likewise, talk to your doctor before you begin any exercise or weight-loss programs to make sure you are healthy enough to continue. There is no “one-size-fits-all” approach to any illness or condition that will be completely successful 100% of the time. Because these are alternatives, not the normal, primary first-line treatments, you may need to experiment via trial-and-error to find the solution that works best for you. You may even need to combine several strategies to maximize their effectiveness. But in the end, such a plethora of choices means that there is nearly ALWAYS another option that you can use to safely and effectively treat your condition without endangering your sobriety.